Provider Demographics
NPI:1316596935
Name:STAGE, TIFFANY CATHERINE (RN)
Entity Type:Individual
Prefix:MR
First Name:TIFFANY
Middle Name:CATHERINE
Last Name:STAGE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2236 E MITCHELL RD STE 5
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-9604
Mailing Address - Country:US
Mailing Address - Phone:231-347-9880
Mailing Address - Fax:231-347-9313
Practice Address - Street 1:2236 E MITCHELL RD STE 5
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-9604
Practice Address - Country:US
Practice Address - Phone:231-347-9880
Practice Address - Fax:231-347-9313
Is Sole Proprietor?:No
Enumeration Date:2019-09-06
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704212582163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse